Provider Demographics
NPI:1952344616
Name:DONIACH, TABITHA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:
Last Name:DONIACH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7446
Mailing Address - Country:US
Mailing Address - Phone:707-478-2457
Mailing Address - Fax:707-843-7501
Practice Address - Street 1:427 DOYLE PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4515
Practice Address - Country:US
Practice Address - Phone:707-244-7934
Practice Address - Fax:707-843-7501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84644OtherSTATE MEDICAL LICENSE
CAA84644OtherSTATE MEDICAL LICENSE